Fountoulakis Konstantinos N, Gonda Xenia, Koufaki Ioanna, Hyphantis Thomas, Cloninger C Robert
From the 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki (Greece) (Dr. Fountoulakis and Ms. Koufaki); Departments of Clinical and Theoretical Mental Health, Kutvolgyi Clinical Center, and of Pharmacodynamics, Semmelweis University (Hungary) (Dr. Gonda); Hungarian Academy of Science-Semmelweiss University Neuropsychopharmacology and Neurochemistry Research Group, Budapest (Dr. Gonda); Department of Psychiatry, School of Medicine, University of Ioannina, Greece (Dr. Hyphantis); Department of Psychiatry, School of Medicine, Washington University in St. Louis (Dr. Cloninger).
Harv Rev Psychiatry. 2016 Jan-Feb;24(1):36-52. doi: 10.1097/HRP.0000000000000077.
Bipolar disorder constitutes a challenge for clinicians in everyday clinical practice. Our knowledge concerning this clinical entity is incomplete, and contemporary classification systems are unable to reflect the complexity of this disorder. The concept of temperament, which was first described in antiquity, provides a helpful framework for synthesizing our knowledge on how the human body works and what determines human behavior. Although the concept of temperament originally included philosophical and sociocultural approaches, the biomedical model is dominant today. It is possible that specific temperaments might constitute vulnerability factors, determine the clinical picture, or modify the course of illness. Temperaments might even act as a bridge between genes and clinical manifestations, thus giving rise to the concept of the bipolar spectrum, with major implications for mental health research and treatment. More specifically, it has been reported that the hyperthymic and the depressive temperaments are related to the more "classic" bipolar disorder, whereas cyclothymic, anxious, and irritable temperaments are related to more complex manifestations and might predict poor response to treatment, violent or suicidal behavior, and high comorbidity. Incorporating of the concept of temperament and the bipolar spectrum into the standard training of psychiatric residents might well result in an improvement of everyday clinical practice.
双相情感障碍在日常临床实践中给临床医生带来了挑战。我们对这一临床实体的认识并不完整，当代分类系统也无法反映该障碍的复杂性。气质概念最早在古代就有描述，它为整合我们关于人体如何运作以及什么决定人类行为的知识提供了一个有用的框架。尽管气质概念最初包含哲学和社会文化方法，但如今生物医学模型占主导地位。特定的气质可能构成易患因素、决定临床表现或改变病程。气质甚至可能成为基因与临床表现之间的桥梁，从而产生双相谱系的概念，这对心理健康研究和治疗具有重要意义。更具体地说，据报道，情感高涨型和抑郁型气质与更“典型”的双相情感障碍有关，而环性气质、焦虑型和易激惹型气质与更复杂的表现有关，可能预示着对治疗反应不佳、暴力或自杀行为以及高共病率。将气质概念和双相谱系纳入精神科住院医师的标准培训中很可能会改善日常临床实践。
